Consider Services and Costs.
Per the Affordable Care Act, all plans must cover the basic 10 essential healthcare services (see minimum requirements for health plans below). However, in addition to these services, carriers may offer additional coverage. The cost of additional coverage will vary depending on level of services covered and who the carrier is. The Affordable Care Act has also mandated that consumers have a choice between four levels of coverage. Accordingly, Platinum covers 90% of your healthcare costs, Gold which covers 80% of your healthcare costs, Silver covers 70% of your healthcare costs and Bronze covers 60% of your healthcare costs.
Accordingly, as you compare monthly premiums, you should also compare copayments, deductibles, and coinsurance.
Copayments – the fixed dollar amount you must pay for a doctor visit or other covered service. Accordingly, for those individuals who visit the doctor frequently, a plan with a low co-pay may be a good choice.
Deductibles – a deductible is the amount you must pay annually before certain healthcare services will be covered. Accordingly, a high deductible, low premium plan is often a good choice for those individuals who are generally healthy.
Coinsurance – after your deductible is met, you will still pay for a portion of your medical services, referred to as coinsurance. For example, many policies pay between 60% to 80% of your healthcare costs, while you cover the remaining 20% to 40%.
You have an annual out-of-pocket maximum that includes copayments, deductibles and coinsurance. Once you reach your out-of-pocket maximum, the insurance company pays 100% of your healthcare costs.
Consider the plan’s healthcare provider network. Whether an HMO or PPO, all health plans have an approved provider network. If you use healthcare service providers outside of the network, there is a good chance those charges won’t be covered by your policy.